Dr Davis, interesting study. But both links go to the same study, Nilsson 2004, shouldn't the second link go to second study?

Hi, Prague-

Absolutely right. Thanks for catching that.

Actually, both observations were best made in the same study. While the effect of milk on insulin secretion is firm, the question of cheese has not been as well explored. There's also the possibility that, because cheese is like wine in that there are thousands of variations (organism chosen for fermentation, fat content, etc.), there might even be variation from cheese to cheese.

I would assume that heavy cream devoid of proteins and carbohydrates would result in less area under the curve?  Are there any studies of this?

How can you have a test meal of cod which contains the same carbohydrate count as a reference bread meal when cod has no carbohydrates?

But I'm not sure why they used reconstituted milk. Why not normal (3.5%) milk, or perhaps normal and skim? They do say, "Interestingly, there is epidemiologic evidence suggesting that overweight subjects with a high intake of milk and dairy products are at a lower risk of developing diseases related to the insulin resistance syndrome" Perhaps because the SFA content?

I know that a tall glass of milk can surprisingly jack up blood sugar, and they say that "The insulin response to milk products does not relate solely on the lactose component." Interesting. Still, much better a glass of milk than a glass of apple juice.

Hi, Stephen--

Yes, crucial distinction. To my knowledge, that has not been done, though I would fully expect that there is no effect.

Hi, Brent--

The cod must have been breaded. The cod they used was purchased in a grocery store.

What about the recent information on trans-palmetic (spc) acid formation being BENEFICIAL to diabetes? More so, forms from raw, full fat dairy?

It would be interesting to see how different sources of milk influence insulin secretion. Aside from the distinct breeds of cattle many pastoralists use goat & sheep; plowmen milk  buffalo and some artic milking of reindeer (it takes 2 people, one to hold the horns).

My dairy consumption is in the form of Kefir "Quark". This is cultured milk that is then drained of it's whey. In the Mediterranean & Mid-east regions they use yogurt "quark"; but named differently by each culture in their own vernacular. In India it would be "curd", and usually from water buffalo milk.

"Quark" is a fermentation process byproduct and the minerals in milk are lost (soluble) in the whey. In other words, there is minimal calcium in "quark".(A few Posts back readers may recall Doc restricting calcium for reducing aortic calcification. Elsewhere, some men may recall having seen prostate studies suggesting excess calcium is not ideal.)

What about full-fat kefir? I no longer consume grains and eat raw cranberries as my small daily portion of fruit. But I will not give up my kefir even if it takes 10 years off my life! So be it.

Heck, no more yoghurt.I'll have to grind flaxseeds or eat eggs for breakfast.

What about heavy whipping cream?  It has low carbohydrate content and high fat.  Did the study differentiate between the different fat contents of milk/cream?

Don't forget "Butter and Insulin".

It was one of Dr. Davis' more controversial blog posts, especially among us butter lovers...

I'm also not quite so eager to throw out my whey protein and BCAA supplements either. Not when they provide the most bio-available protein that has long been proven to be beneficial for human muscle synthesis.  Why eliminate a dietary source that can help tip the balance toward a favorable muscle to fat composition ratio?... that in turn actually improves fat metabolism and insulin sensitivity?

Study used 28 gr. spray dried whey (among other items) that was reconstituted in 550 gr. water. It showed that whey had fastest uptake of insulin-otrophic (secretagogue) amino acids (namely leucine, valine, isoleucine, lysine and theonine).

Compared over 1.5 hours to same gr. weight of white bread (studies reference food) whey's insulin reaction was 90% greater. It's blood glucose however rose notably less than the reference food's blood sugar did.

I'd like to understand better the way insulin "spikes" have beneficial functions in non-diabetics. It seems to me that there may be times of day (circadian) when elevated insulin serves a signalling purpose; late night in front of the TV seems unlikely. Anybody?

Pretty damn depressing. Is it safe to breathe still? Can someone explain what the observed danger of eating Whey Protein actually is. This seems to be quite speculative.

Someone please correct me if I am mistaken - but I think that what this boils down to is the amount of lactose in a particular dairy product and would that not explain the difference between, for example, the effects of milk v.s cheese?

Hi Terry,
Cheese doesn't have the whey any more; it gets drained off. The whey proteins are the insulin spiker (Doc's post is on how insulin reacts). Milk's lactose (milk sugar) apparently has more to do with the way blood glucose (sugar)reacts to milk, irregardless of the milk still containing it's whey.

Did anyone actually read the study.  The cod was not breaded, they added lactose to each product to bring the carb count up to 25g, including the cod.

Also, yogurt is not mentioned at all in this study, so not sure why you are lumping it in here.

It would be difficult to design a diet using the II of these two papers, because their insulin index (II) is based on equal carb portions. Some foods do not have much carbs, so they add carb (lactose) to them.  A better table for a variety of foods is given in this  paper * where II is calculated based on equal calorie portions, so we know the weight of each portion (from Table 2).  In this paper the values for GI (glucose index) and II are (from Table 4)

Food
Weight gr
GI
II
White bread
Yogurt
Cheese
Eggs
Beef
94
241
59
159
158
100
62
55
42
21
100
115
45
31
51

(how do you paste atable here???)

Some of the GI of the protein-rich foods is due to  glucagon  which raises blood sugar levels by gluconeogenesis.  The GI and II of cheese, eggs and beef are not much different,  but for yogurt II is almost double of its GI.

* An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods
http://www.ajcn.org/content/66/5/1264.full.pdf+html

Don't forget they are testing isolated products for blood sugar impact. The impact will be blunted if combined with something that has that effect. Like adding eggs to a whey protein shake.

So the whey protein isolate (100%) protein that I add to my morning smoothie is causing an insulin spike?

My greek yogurt as well? (high protein, low carb)

I always understood that milk was high carb and would cause a spike, but these others are bewildering.

Bodybuilders favor whey protein for its insulin spiking properties. Their idea that the insuin drives creatine and amino acids to muscle tissue Ne c'est pas?

Could they be engaging in diabetogenic behavior?

These insulin-boosting properties of some foods (especially dairy, and yes, fish) appear to have been well known for awhile:

http://www.mendosa.com/insulin_index.htm

The site lined below suggests eating carbs in the morning before and immediately after working out, to help achieve the holy grail of nearly all who work out -- that is, lose fat, build muscle. Can't vouch for the validity of this, but here it is:

http://shadowfit.com/articles/index.php/archives/794

So, the fundamental question remains. Is it the spike or the area under the curve that is the worst? Kind of like radiation, now back in the news because of Fukishima

Mike

Hi Terry,
Greek yogurt is reduced whey (they drain some off); that's how they make it thicker.
Yogurt's carb level is less than milk because the fermentation bacteria mainly fed on the milk sugar(lactose).

Bodybuilders favor whey protein for its insulin spiking properties. Their idea that the insuin drives creatine and amino acids to muscle tissue Ne c'est pas?

Could they be engaging in diabetogenic behavior?

These insulin-boosting properties of some foods (especially dairy, and yes, fish) appear to have been well known for awhile:

http://www.mendosa.com/insulin_index.htm

The site lined below suggests eating carbs in the morning before and immediately after working out, to help achieve the holy grail of nearly all who work out -- that is, lose fat, build muscle. Can't vouch for the validity of this, but here it is:

http://shadowfit.com/articles/index.php/archives/794

So, the fundamental question remains. Is it the spike or the area under the curve that is the worst? Kind of like radiation, now back in the news because of Fukishima.

Mike

Right thats dairy of the list now. Not much left to eat!

@Jason R. lol too right... there will be an epidemic of malnourished dead people with perfect arteries !

Just don't understand (other than water and air) what's ok to eat...

It appears we can safely conclude that just eating (anything!) will spike your insulin!

I am not sure what's left that hasn't been found to be problematic to health in some way

It all makes for good news stories though!

praguestepchild gives us the money quote which I shamelessly repeat here:

"Interestingly, there is epidemiologic evidence suggesting that overweight subjects with a high intake of milk and dairy products are at a lower risk of developing diseases related to the insulin resistance syndrome"

We are left to conclude that with dairy you look bad on paper but turn out to look pretty darn good in real life.  Especially considering that overweight would be associated with higher risk of insulin resistance syndrome indicating, potentially, that dairy actually has a powerful protective effect.

So Terry, Jason cheer up!

It would be difficult to design a diet using the insulin index (II) given in these two papers, because their  II values are based on equal carb portions. Some foods do not have much carbs, so the studies of both papers add carb (lactose) to them and that creates unrealistic foods (but proves their point).   A better table for a variety of foods is given in the paper * below where II is calculated based on equal calorie portions, so we know the weight of each portion (see Table 2). See Table 4  for the values for GI (glucose index) and II.

I think, some of the high GI of the protein-rich foods is not due to their high carb content, but their release of glucagon,  which raises blood sugar levels by gluconeogenesis.  The GI and II of cheese, eggs and beef are not much different, but for yogurt, II is almost double of its GI.

* An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods
Susanne HA Holt, Janette C Brand Miller, and Peter Petocz
http://www.ajcn.org/content/66/5/1264.full.pdf+html

Is it not possible whey's sustained insulin response indicates it is part of a feed back loop? For active people (ex: body builders, herdsmen) the dynamic is more valuable than for the sedentary; modern sedentary lifestyle & insulin spike are a different dynamic.  

Many crucial cells must get their glucose diffused to the extra-cellular spaces; blood doesn't get to touch every cell.
Insulin "spike" and steady reign may be evolutionary to give crucial cells chance to sip some glucose. The spike is a signal
there's plenty for every cell; it prevents first come first served cells from going into overdrive and pulling in all the blood glucose.

"By conventional wisdom, this may be a good thing, but not in my book."

Well dear doctor we are all entitled to opinions, but in this particular case your book needs revision:

A population-based prospective study (CARDIA) revealed that dairy consumption was inversely associated with the incidence of all components of the insulin resistance syndrome (IRS) among overweight individuals (BMI>=25kg/m2).

*** Each daily occasion of dairy consumption was associated with 21% lower odds of IRS. ***

These associations were similar for blacks and whites and for men and women.


If you believe this to wrong, please direct us to what bases your conclusion.

Hi Annon.,
? Insulin resistance decreased by dairy in what form; ie:
hard cheese (essentially no whey), klabbered (yogurt/kefir) with bacteria, fluid w/or w/o "x" % milk fat ...? My reply to you on "Smoothies" thread got lost, so am pleased you posted again here.

BMI is a ratio of proportionality to the persons height. A tall and thin individual can score a higher BMI than a short and fat one. BMI doesn't tell ratio of lean:fat in our body mass.

One day I'd like to see all studies use their subject's "Ponderal" proportion. This is the individual weight (in kilograms) divided by their height cubed (in meters).

It is superior for assesing what's happening with obesity. The "ponderal" change will reflect basal inflammation and can be cross-referenced to previous C Reactive Protein measurements to track if any complication are occuring.

Is there a home insulin meter, like the home glucose meter? It would help a lot.

We tend to over think things latching on to this isolated nutrient or that. Your overall diet is what counts. People have been drinking milk/yoghurt/kefir and eating cheese for thousands of years. Dairy is a pretty damned good food (especially cheese).

It seems to me that Weston Price (the man and organization) has it just about right.

Many of the non distilled forms of Fish oil seem to specify varying amounts of cholesterol contamination , + saturated fat etc.  In the pharmaceutical or distilled types most of the fat content is accounted for by the omega-3 content while in most over the counter types you will find varying amounts of additional fat and cholesterol specified. (Nature Made for example has the following:
Per 2 Softgels: Calories 25 (Calories From Fat 20); Total Fat 2.5 g (Saturated Fat 1 g; Polyunsaturated Fat 1 g; Monounsaturated Fat 0.5 g); Cholesterol 25 mg; Protein 2 g; Fish Oil Concentrate 2400 mg (Omega-3 [EPA] Eicosapentaenoic Acid 360 mg; Omega-3 [DHA] Docosahexaenoic Acid 240 mg); Gelatin (Non-Bovine); Glycerin; Water; Tocopherol.

Will insurers cover Omacor?  I don't know...

If so, I know a number of people who would go get a script today.  The out-of-pocket costs for supplements just aren't in some people's budgets.  But I agree with you, it's a shame the system is designed to support such blatant profit for so few people.

Omacor is a prescription drug and it is covered by my insurance. I pay $90 for a three-month supply, that is four capsules a day for a total of 360 capsule. It is also covered by my flexible spending account, so that saves me about 30% tax. I effectively pay about $63 for three months. So the cost per capsule is about 17.5 cents.

Don't kid yourself:

You may pay $63 for a prescription out of pocket, but you and society pay a far larger price of $240 per month through increased health insurance costs. All of us ultimately bear the higher price. In this instance, all the excess profits go into Omacor's pockets, thanks to the brainwashing of the public and physicians.

Its amazing that Physicians, who lead their life using medicines and treatment protocols which are based on clinical research, discourage the use of the only truely clinically proven, regulated, prescription Omega 3 acid available.  The benefits of this product extend far past its triglyceride lowering effects, which makes it a product that should be considered for positive health as well as disease treatment.  The clinical studies are horrifically expensive, a natural based product is unpatentable, therefore making whomever is willing to put millions of dollars into making sure the clinical background is well tested, take a large risk. Copycat, unproven, dietary supplements (by the way which are monitored by the same people who monitor kit kats and gatoraid)make unsubstantiated claims. Shouldn't the developers and companies of this pharmaceutical product be  repaid, profit, and also be supported enough to continue the clinical research and development of such products.  If only the worlds medications were made up of more natural based solutions I believe we would be much more satisfied and less at risk of side effects from strictly chemically "isolated" molecules.  Omacor (which is now Lovaza) provides a glimpse of what practitioners have been looking for, a natural based prescription medication, effective, clinically proven to lower triglycerides similarly to other available therapies (with less expected drug to drug interactions or adverse events) and controlled so it is easier to recommend and use by health care professionals.  What is the sociatal cost of frequent LFT's, myopathy, rhabdo, Drug to Drug interactions from 145 fenofibrate?  Not the POOLED representation of Adverse events in the PI, that my good Doctor is trickery.  The 48mg might be more innocuous, but the 145mg is still risky and even recently had many other interactions and warnings added.  That is still considered a good drug, effective, possibly safer than the alternative of no treatment, but it does say to mind the "risk benefit ratio" which is thrown to hell when products like Omacor (Lovaza) come to market proven to work without expected side effects.  You might want to rethink how you see the companies and industries that develop the future of medicine.  No one is perfect, nor totally disclosed, however this product is certainly a step in the right direction and should be supported, not stiffled.

Anonymous--

I think you may have missed the point of the post.

I was not bashing Omacor/Lovaza because it is fish oil. I have been using fish oil for years with excellent results, preparations that work wonderfully and cost around $3 per month.

Now, there's a fish oil that costs $130+ per month? Purer? I would like to see side-by-side comparisons; I have seen no such thing. There are over-the-counter, highly purified preparations available without prescription and for less than a tenth of the cost of Omacor/Lovaza.

I agree that fish oil in some form should precede the use of fibrates like Tricor. I rarely use Tricor, even though much of my cardiology practice has evolved into a lipid consulting practice.

I guess my point is specifically, if you support $3 fish oils and their use, will those companies obediently go out and do the clinical studies that you need to feel secure to treat your patients?  Business and price per product does not come cheap.  The studies done, the missed compounds, the intergration into a patented item, the production, and the standards and guidelines all factor into the price of a product.  I just believe it to not only be unfair to recommend that patients use other than the proven product (unless there is no alternative) but also bad business sense.  If there is not loyalty or ethical appreciation to the developers and testers of these pharmaceutical products, who will then develop medicine?  I believe it would be futile to compare regular fish oil to Lovaza, just as it would be futile to compare most other drugs head to head.  The difference between relative/ actual and clinical vs. theraputic significance is very hard to show.  However, the dosing (4per day vs 8 t0 15 of reg fish oil), the purity (excursions from storage parameters render the compound less or ineffective = lack of controled standards)the purity (many manufactures are continuously being warned from FDA about the consistancy of product) and the lack of attributable cause data linking other less pure concentrations to actual clinical outcomes are all reasons that a seasoned medical professional like yourself should support the use of Lovaza instead of Fish oil capsules whenever possible.  I do know there are studies in europe about dosing regimin vs. clinical lipid results.  I would expect that at 8-15 fish pills per day the outcome results would be similar, however more variation and much more fat and omega 6's per pill.  Compliance would be less than optimal, outcome would be less than optimal, and with any alternative prescription that provides confidence in all variable and clinical aspects, this should be commended and supported whenever possible rather than talking about "brainwashing the public and physicians."  I wish someone would figure out that for every product that is developed, tested, and brought to market there are 20 other products that are in some stage of development and fail to be approved.  If EACH drug that comes to market costs approx $1.2 billion dollars (Tufts CSDD 2006), how much do you think is lost with the other 10-20 drugs that fail to gain approval?  Somewhere between 100 and 500 million PER FAILED DRUG!  Multiply that times the 10-20 that failed and you have approximately  6,000,000,000 (6 billion dollars).  With that said, it takes a lot more than just actual production cost to reimburse for past, present, and future research and development, business expenses, and of course profits to keep the company developing key breakthrough products.  All I am saying is that I understand and commend you for using an agressive alternative therapy addition in your patients to increase their health and hopefully life.  I do however believe that there is a blame game in medicine created or exacerbated by insurance companies that leads to finger pointing about medical necessity and cost.  People look towards trimming expenses in all places, however if drugs like Lovaza (not just fish oils) are not appreciatively embraced by practitioners and supported/ recommended whenever possible, there will be no more drugs or better yet, alternative large scale studies done on this kind of unpatentable compound because physicians assume similarities and switch to a compound like Dietary supplements.  Sorry, Ill step down from my soap box now, however this is definitely a sore spot for me.

Do you work for a pharmaceutical manufacturer?

Is it the same sort of economics that allows the founder/CEO of Kos Pharmaceuticals to cash out for $2.3 billion in personal payout, followed by the company raising the price of Niaspan?

The answer, in my view, is not to gouge the public with extravagant drug prices, but to support non-profit-seeking research.

Dear Dr Davis,

I had to comment on this old blog as I am in the UK. Up until yesterday I was buying omega-3 fish oil from my health food shop, an amount to give me 2250 mg per day, that is 1125 mg EPA and  750 mg DHA, and it was costing me in the region of £25 per month. I have a bicuspid aortic valve with moderate stenosis and talking about omega-3 fish oils with my cardiologist he suggested that I be prescribed Omacor instead. The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it

I would love to have some studies, though, which show the positive effect of omega-3s on coronary calcification.

Anne

Anne said, "...my cardiologist...suggested that I be prescribed Omacor...The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it ".
I left hospital a month ago with a prescription list that included Omacor but when I visited my NHS GP for a repeat prescription I was told that I could buy this item for myself, over-the-counter. :-(

"If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form."

Lovaza capsules contain >80% purified EPA and DHA (465 mg and 375 mg, respectively), which are purified from fish oil.  The other oils are fish oils, and could possibly be omega-3s.  You must take at 2-4 for triglyceride lowering (at least one for CV risk reduction in AVD patients).  

I don't know about any specific manufacturers OTC, but I do know that typical products contain 120mg DHA and 180mg EPA per GRAM of capsule. This means that only 30% have been confirmed to be the beneficial oils.  What else is in there?  This is why Lovaza does not have a fishy aftertaste, but OTC ones do.  Also, look how many you would have to take to equal the DHA and EPA in Lovaza.  It is not ANY fish oil, but specifically DHA and EPA that is necessary for CV benefit.

Alpha linoleic acid MUST BE ACTIVATED to give CV benefits, and humans only activate 10% of alpha linoleic acid, so products claiming to have a ton of omega 3s using this compound are giving their values of omega-3s via a technicality (alpha linoleic acid is "technically" an omega-3).  

This is not to mention the whole issue of herbal/supplement companies basically able to put anything in a capsule as long as it isn't harmful, REGARDLESS of what they say it is.  The FDA just doesn't care to watch these companies much.  

Therefore, if I had the money, I would go Lovaza, but I am a cheap @$$ and would rather go with a USP Verified OTC product and take my chances

Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.